Tuesday, October 04, 2011

The Morning Drill: October 4, 2011

More Americans are delaying dental care due to cost, and many are open to the concept of a new type of dental care provider if it would make more services available to those who currently cannot afford them, according to a survey released today by the W.K. Kellogg Foundation.

According to the survey of 1,023 adults nationwide, 41% of respondents reported that they or someone in their household has put off dental care because of cost, and 30% said they do not have a place to receive dental care. In addition, 79% said that receiving regular dental care is important, but 40% said they do not have dental insurance.

And more than 80% said they believe it is difficult for people to get free or low-cost dental care in their communities and that the number of Americans who cannot access dental care is "a problem."

Those most likely to be putting off care due to cost are those with annual incomes of less than $30,000 (55%), those without dental insurance (54%), and those with a high school diploma or less (47%). In addition, Latinos (47%) are more likely than African Americans (36%) and whites (42%) to have put off dental care in the last 12 months due to costs. Women are also more likely than men (47% versus 35%) to have put off dental care because of cost.

"This survey clearly shows that people throughout the country are struggling to get dental care," said Sterling Speirn, president and CEO of the W.K. Kellogg Foundation.

One of the most surprising findings, according to Mike Perry, an analyst and partner at Lake Research Partners, the company that conducted the survey, came in response to this question:

Many efforts are going on to improve affordable access to dental care in our country. One effort is training license dental practitioners to provide preventive, routine dental care to people who are going without care. Would you support or oppose this effort to train licensed dental practitioners?"

More than three-quarters (78%) of survey respondents said they would support the training of licensed dental practitioners to make preventive, routine dental care more accessible, according to the survey.

"We did not provide them with a definition of dental therapists," Perry said. "You introduce the idea of a midlevel dental professional who is out in the community providing routine and preventive dental care and they say, 'Oh, OK, like a physician's assistant.' This research suggests that the general public is open to someone other than a dentist providing routine and preventive care."

Behavior-based weight loss interventions are safe and effective, according to a systematic review published in the October 4 issue of the Annals of Internal Medicine.

A 2007-2008 study showed that 32% of US men and 36% of US women were obese. The US Preventive Services Task Force recommends that physicians screen all adults for obesity and institute intensive counseling and behavioral interventions for obese adults.

The researchers, led by Erin S. LeBlanc, MD, MPH, from the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, reviewed studies of primary care-relevant weight loss interventions for overweight and obese adults. The studies were pulled from MEDLINE, the Cochrane Central Register of Controlled Trials, and PsycINFO (January 2005 - September 2010) and from systematic reviews for studies conducted before 2005.

An overall healthy diet -- not just folic acid supplementation -- may be key to reducing risk of neural tube and orofacial cleft birth defects, a population-based study indicated.

Prepregnancy dietary quality in terms of fruits and vegetables, grain, calcium, iron, and folate, as well as fat and sugar intake, significantly predicted risk of these defects even after controlling for supplement use, Suzan L. Carmichael, PhD, of Stanford University in Stanford, Calif., and colleagues found.

The highest quality diets were associated with up to 51% lower risk of anencephaly, 34% reduced risk of cleft lip, and 26% lower odds of cleft palate compared with the poorest diets.

These links were stronger than seen with folic acid or other nutrients individually in a prior analysis of the same cohort, the group reported online in the Archives of Pediatrics & Adolescent Medicine.

"It's important to think of nutrition in all of its complexity," Carmichael told MedPage Today.

That doesn't mean the emphasis on boosting folic acid intake through supplements and fortification of the food supply has been misplaced, Carmichael cautioned in an interview.

Folic acid clearly can prevent neural tube defects, which have dropped in prevalence since food fortification, she pointed out, calling it "a huge public success story."

But further progress in tackling the still extensive burden of these birth defects that develop often before women are even sure they are pregnant may require a more whole-diet approach, her group argued.

College students' Facebook pages might hold clues to which of them are at risk for alcohol dependence and abuse, according to a new study.

Researchers found that students who had pictures or posts about getting drunk or blacking out were more likely to be at risk of drinking problems, based on a screening test. That was not necessarily the case for students who mentioned alcohol or drinking on their pages, but not in a way that showed that they drank too much or in unhealthy situations.

It's possible that Facebook pages could help schools find out who needs to be assessed for alcohol-related problems -- although privacy and ethical concerns might make that complicated, researchers said.

The question is whether "what's being found on these sites... is actually predictive of clinical conditions," said Dr. James Niels Rosenquist, a social media researcher and psychiatrist from Massachusetts General Hospital who wasn't involved in the new study.

The findings suggest that messages on Facebook sites do seem to be linked to what happens in the "real world," he told Reuters Health.